Prior Authorization Pro — Pharmacy Tech

JobRx, Inc.; Plano (TX); On-site; USD 52,000 - 76,000; Full time

Benefits offered by this job

Paid sick leave

Health benefits

401k

Short-term disability

Term life insurance

Job summary

JobRx, Inc. is seeking a skilled Prior Authorization Specialist to join its healthcare operations team. The role focuses on managing and processing prior authorization requests to ensure timely patient care and compliance with policies.

The ideal candidate has at least 2 years of full PA lifecycle experience, familiarity with CoverMyMeds, and a licensed Pharmacy Technician with retail experience is preferred. Onsite schedule is Monday to Friday, 8:30 a.m. – 5:00 p.m.

Qualifications

• MUST have at least 2 years of experience managing the full PA lifecycle including benefit investigation, document collection, PA submission, follow-up, appeals, etc.
• Experience with CoverMyMeds highly preferred.
• Licensed Pharmacy Tech with retail experience preferred.

Responsibilities

• Prior Authorization Submission & Processing: Prepare and submit PA requests through payer portals, fax, phone, or electronic systems with required documentation.
• Prior Authorization Status Follow-Up: Contact insurers to obtain real-time status updates and resolve delays.
• Reject Code Review & Resolution: Interpret and address payer edits and claim rejections to determine next steps.
• Documentation & Data Entry: Enter PA letters, authorization numbers, and related details into CareTend and other systems.
• Denial Review & Routing: Review denial letters and route to Clinical Utilization Team for review and appeals.
• Queue & Workflow Management: Monitor PA queues to ensure timely follow-up and prioritization.
• Payer Communication & Tracking: Maintain notes of interactions, reference numbers, and authorization status.

Skills

PA lifecycle experience

CoverMyMeds experience

Education

Licensed Pharmacy Technician

Job description

JobRx, Inc. is seeking a skilled Prior Authorization Specialist to join its healthcare operations team. The role focuses on managing and processing prior authorization requests to ensure timely patient care and compliance with policies.

The ideal candidate has at least 2 years of full PA lifecycle experience, familiarity with CoverMyMeds, and a licensed Pharmacy Technician with retail experience is preferred. Onsite schedule is Monday to Friday, 8:30 a.m. – 5:00 p.m.